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Glossary

Timely Initiation of Care

A CMS home health quality measure: the percentage of episodes in which the start or resumption of care happened within two days of the referral date or the inpatient discharge date, whichever is later. It is reported publicly on Care Compare.

Also timely start of care, TIC

Timely Initiation of Care is the measure that turns the start of care clock into a public number. For each episode it asks whether the start or resumption of care occurred within two days of the referral, or within two days of the inpatient discharge when the patient came from a facility, whichever is later. The agency’s percentage is reported on Care Compare, where referral sources and families can read it.

Two things make the measure harder than the 48-hour rule in 42 CFR 484.55 suggests. The first is that the measure counts from the referral date the agency recorded, and a referral that waits on paperwork before it is accepted still counts from when it arrived. The second is that an agency cannot safely deliver the first visit without the orders, the face-to-face documentation and some account of the patient’s medications, and when the referral packet arrives without them the two days go to getting them.

A 2021 study of 48,497 Medicare home health episodes following a hospital discharge found a third started more than two days after discharge (Song et al., JAMDA). The agencies in that sample were not short of nurses on the day; they were short of what the nurse needed to go. How a home health agency gets hospital records before the start of care walks through the four routes.

Where it is defined

Vivlio for home healthThe face-to-face note, orders, discharge summary and medications, assembled before the first visit.

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